Your browser doesn't support javascript.
loading
Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.
Handy, Alex; Banerjee, Amitava; Wood, Angela M; Dale, Caroline; Sudlow, Cathie L M; Tomlinson, Christopher; Bean, Daniel; Thygesen, Johan H; Mizani, Mehrdad A; Katsoulis, Michail; Takhar, Rohan; Hollings, Sam; Denaxas, Spiros; Walker, Venexia; Dobson, Richard; Sofat, Reecha.
Afiliação
  • Handy A; Institute of Health Informatics, University College London, London, UK alex.handy.research@gmail.com.
  • Banerjee A; Institute of Health Informatics, University College London, London, UK.
  • Wood AM; University College London Hospitals National Health Service Trust, London, UK.
  • Dale C; Barts Health National Health Service Trust, The Royal London Hospital, London, UK.
  • Sudlow CLM; British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Tomlinson C; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
  • Bean D; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
  • Thygesen JH; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK.
  • Mizani MA; Institute of Health Informatics, University College London, London, UK.
  • Katsoulis M; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK.
  • Takhar R; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
  • Hollings S; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
  • Denaxas S; Institute of Health Informatics, University College London, London, UK.
  • Walker V; University College London Hospitals National Health Service Trust, London, UK.
  • Dobson R; UKRI Centre for Doctoral Training in AI-enabled Healthcare Systems, University College London, London, UK.
  • Sofat R; National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK.
Heart ; 108(12): 923-931, 2022 05 25.
Article em En | MEDLINE | ID: mdl-35273122
OBJECTIVE: To evaluate antithrombotic (AT) use in individuals with atrial fibrillation (AF) and at high risk of stroke (CHA2DS2-VASc score ≥2) and investigate whether pre-existing AT use may improve COVID-19 outcomes. METHODS: Individuals with AF and CHA2DS2-VASc score ≥2 on 1 January 2020 were identified using electronic health records for 56 million people in England and were followed up until 1 May 2021. Factors associated with pre-existing AT use were analysed using logistic regression. Differences in COVID-19-related hospitalisation and death were analysed using logistic and Cox regression in individuals with pre-existing AT use versus no AT use, anticoagulants (AC) versus antiplatelets (AP), and direct oral anticoagulants (DOACs) versus warfarin. RESULTS: From 972 971 individuals with AF (age 79 (±9.3), female 46.2%) and CHA2DS2-VASc score ≥2, 88.0% (n=856 336) had pre-existing AT use, 3.8% (n=37 418) had a COVID-19 hospitalisation and 2.2% (n=21 116) died, followed up to 1 May 2021. Factors associated with no AT use included comorbidities that may contraindicate AT use (liver disease and history of falls) and demographics (socioeconomic status and ethnicity). Pre-existing AT use was associated with lower odds of death (OR=0.92, 95% CI 0.87 to 0.96), but higher odds of hospitalisation (OR=1.20, 95% CI 1.15 to 1.26). AC versus AP was associated with lower odds of death (OR=0.93, 95% CI 0.87 to 0.98) and higher hospitalisation (OR=1.17, 95% CI 1.11 to 1.24). For DOACs versus warfarin, lower odds were observed for hospitalisation (OR=0.86, 95% CI 0.82 to 0.89) but not for death (OR=1.00, 95% CI 0.95 to 1.05). CONCLUSIONS: Pre-existing AT use may be associated with lower odds of COVID-19 death and, while not evidence of causality, provides further incentive to improve AT coverage for eligible individuals with AF.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Acidente Vascular Cerebral / COVID-19 Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Acidente Vascular Cerebral / COVID-19 Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article